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Pathology - Reflux nephropathy
Definition: Renal scarring linked to vesicoureteric reflux (VUR), a congenital condition characterized by the retrograde flow of urine from the bladder into the upper urinary tract.
Epidemiology: A significant contributor to chronic kidney disease, accounting for around 30% of cases in pediatric populations and 10% in adults.
Aetiology: Vesicoureteral Reflux (VUR). It is important to note that not all cases of vesicoureteral reflux (VUR) are complicated by reflux nephropathy (RN).
Pathogenesis • Believed to be caused by the reflux of contaminated urine into the kidney. Intra-renal reflux typically occurs near the poles of the kidneys, where compound papillae are located. Compound papillae exhibit increased susceptibility to reflux due to the papillary ducts opening at less oblique angles onto a flat or concave surface. The immediate inflammatory reaction to the infection results in kidney scarring. • The loss of adequate nephron mass leads to the progression of renal disease.
Presentation • Patients commonly have hypertension and/or proteinuria. • When renal scarring is substantial, biochemical indicators of renal failure become apparent.
Macroscopy • The renal poles have regions of coarse cortical scarring. Histopathology: The scarred regions exhibit characteristics of chronic pyelonephritis, including tubular atrophy and interstitial fibrosis, accompanied by a mononuclear inflammatory cell infiltrate. Some tubules are collapsed, while others may be dilated and filled with proteinaceous material, a condition referred to as 'thyroidization.' • Remaining glomeruli exhibit hypertrophy and subsequent glomerulosclerosis.
This constellation of characteristics is not exclusive to reflux nephropathy and may also be observed in other situations, including obstructive nephropathy. The differentiation between the two is typically achievable, depending on the clinical presentation and the scarring pattern.
Complications • Recurrent urinary tract infections. • Renal calculi. • Chronic kidney disease
Definition: Renal scarring linked to vesicoureteric reflux (VUR), a congenital condition characterized by the retrograde flow of urine from the bladder into the upper urinary tract.
Epidemiology: A significant contributor to chronic kidney disease, accounting for around 30% of cases in pediatric populations and 10% in adults.
Aetiology: Vesicoureteral Reflux (VUR). It is important to note that not all cases of vesicoureteral reflux (VUR) are complicated by reflux nephropathy (RN).
Pathogenesis • Believed to be caused by the reflux of contaminated urine into the kidney. Intra-renal reflux typically occurs near the poles of the kidneys, where compound papillae are located. Compound papillae exhibit increased susceptibility to reflux due to the papillary ducts opening at less oblique angles onto a flat or concave surface. The immediate inflammatory reaction to the infection results in kidney scarring. • The loss of adequate nephron mass leads to the progression of renal disease.
Presentation • Patients commonly have hypertension and/or proteinuria. • When renal scarring is substantial, biochemical indicators of renal failure become apparent.
Macroscopy • The renal poles have regions of coarse cortical scarring. Histopathology: The scarred regions exhibit characteristics of chronic pyelonephritis, including tubular atrophy and interstitial fibrosis, accompanied by a mononuclear inflammatory cell infiltrate. Some tubules are collapsed, while others may be dilated and filled with proteinaceous material, a condition referred to as 'thyroidization.' • Remaining glomeruli exhibit hypertrophy and subsequent glomerulosclerosis.
This constellation of characteristics is not exclusive to reflux nephropathy and may also be observed in other situations, including obstructive nephropathy. The differentiation between the two is typically achievable, depending on the clinical presentation and the scarring pattern.
Complications • Recurrent urinary tract infections. • Renal calculi. • Chronic kidney disease
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